MHA Today | September 1, 2017

September 1, 2017

MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.

Insights

Congress has a full plate when it returns after Labor Day. Several important health care items are on the agenda with a hard deadline of Sunday, Oct. 1. A long-term solution to the Affordable Care Act’s Medicaid disproportionate share hospital cuts is among the most important.

Reductions in state Medicaid DSH allotments were included in the ACA with the expectation that hospitals would have more insured patients and, as a result, need less federal help to offset the costs of the uninsured. In states like Missouri, that hasn’t been the case. The absence of Medicaid expansion has left hundreds of thousands of otherwise eligible Missourians within the ranks of the uninsured. Uncompensated care has not dropped at the pace experienced in expansion states. And, without a smart DSH policy, the harm to Missouri and the other 18 nonexpansion states through Medicaid DSH allocation cuts would be pronounced.

Earlier Congresses have kicked the can down the road. Originally slated to take effect Jan. 1, 2014, DSH cuts were delayed in 2013, 2014 and 2015. However, the total amount of Medicaid DSH cuts has increased with each delay, so the financial Sword of Damocles remains above us, with an even sharper blade. While Missouri’s Medicaid DSH cuts in this first fiscal year are expected to be negligible because of CMS’ DSH audits, subsequent years get increasingly harsh.

Earlier this week, MHA sent a letter to Centers for Medicare & Medicaid Services’ Administrator Seema Verma presenting options for the proposed DSH rule released in late July. The proposed rule specifies how the reductions in state Medicaid DSH allotments will occur. CMS has indicated that a final rule will be released before Oct. 1. However, there are many unknown issues with very real financial consequences.
If the Medicaid DSH allotment reductions take effect Oct. 1, Missouri’s share appears to be $2.2 billion through fiscal year 2025. However, we can’t know for sure. Some of the data needed to assess the effect of the proposed regulation will not be available until well after the final regulation is issued.

In our letter to Verma, we recommended delaying the proposed state DSH allotments — something we believe CMS has the authority to do. This would allow time to evaluate the options that we recommended, or other options that may bring additional equity to the program.

The best result, which could be achieved through a variety of approaches, would be to link states’ DSH needs with long-term policy goals. Until there’s a level playing field for ACA coverage, the disparities between expansion and nonexpansion states will require a reshuffling of federal DSH allotments.

Absent a total reset of the ACA, this problem will remain. Kicking the can down the road doesn’t make sense. It’s time to pick up the can, recycle the policy, and get the resource back to where it can do the most good.

Anthem Exits Insurance Marketplace In 16 Counties And City Of St. Louis

Anthem has announced that it will stop participating in the federal health insurance marketplace in 16 Missouri counties and the City of St. Louis in 2018. The counties are: Barry, Boone, Christian, Franklin, Greene, Jasper, Jefferson, Lawrence, Lincoln, Newton, Saint Charles, Saint Francois, Saint Louis, Sainte Genevieve, Warren and Washington. Anthem’s exit will not create any counties with no insurer, according to the company, but will increase the number of Missouri counties with one insurer offering. Anthem currently offers plans in 85 Missouri counties.

Senate Finance Committee Schedules Hearing On CHIP Reauthorization

The Senate Finance Committee will conduct a hearing on the reauthorization of the Children’s Health Insurance Program on Thursday, Sept. 7. The current law authorizing CHIP expires Saturday, Sept. 30, and Congress must renew it for the program to continue. CHIP extends health care coverage for children with family incomes above the federal Medicaid standards. Missouri’s CHIP funds provided health care coverage to almost 88,000 kids during federal fiscal year 2016. Bipartisan support for CHIP portends its renewal, although the number of years Congress will extend the program and states’ matching requirements remains uncertain.

Consider This ...

A 2016 survey of prime-age men 25 to 54 who were not in the labor force — defined as not employed or looking for work — found that 47 percent had taken a pain medication on the previous day, and among those, nearly two-thirds had taken a prescription pain medication.